Nifedipine ER

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Oct 25, 2023

Warnings

Nifedipine Risks, Warnings, and Complications

Nifedipine can cause or worsen health problems in some people. Talk to your doctor or pharmacist about taking other medications for your condition if you are at an increased risk of adverse events from this drug.

EXCESSIVE BLOOD PRESSURE REDUCTION: Most people tolerate nifedipine well, but some patients receiving nifedipine can develop excessively low blood pressure. Symptoms of hypotension (low blood pressure) may include dizziness and lightheadedness. This is most likely to occur when you first start treatment and after dose adjustments. Patients receiving concomitant diuretics or concomitant beta blocker therapy are at an increased risk of severe hypotension. These effects typically go away once your body gets used to the medicine. Get up slowly from a sitting or lying position to standing to prevent falls. Tell your healthcare provider if you have severe dizziness.
WORSENING CHEST PAIN OR HEART ATTACK: Rarely, for unclear reasons, some people with severe coronary artery disease develop worsening chest pain or even a heart attack after starting nifedipine or after a dosage adjustment. If you are on beta blocker medications, do not stop taking them suddenly before starting nifedipine, as this can result in increased angina. Get emergency medical help if you experience severe, crushing chest pain, pain that radiates to your jaw, or a pounding or racing heartbeat.
CONGESTIVE HEART FAILURE: In a very small number of people, starting nifedipine can cause congestive heart failure. This is more likely to happen if you are taking beta blockers or have aortic stenosis (narrowing of the aortic valve in the heart). Call your doctor immediately if you develop symptoms of heart failure, such as difficulty breathing, swelling in your legs, or rapid weight gain. Note that swelling in the legs (moderate peripheral edema) occurs as a side effect of nifedipine, especially at high doses, and this does not necessarily indicate heart failure, but it should be monitored by your healthcare provider.
SERIOUS GASTROINTESTINAL OBSTRUCTION REQUIRING SURGERY: Rarely patients treated with nifedipine can develop intestinal blockage or stomach ulcers. These complications may even require surgical treatment. Risk factors include strictures (narrowing) in the stomach or intestines, a history of stomach or intestinal problems such as inflammation, slow bowel movements, or cancer, and taking medications that slow the movement of food through the digestive tract. Before starting nifedipine, tell your provider if you have any digestive tract problems. Call your doctor without delay if you develop stomach pain, bloating, gas, or difficulty passing stool.

Precautions Before Starting Nifedipine

Tell your doctor if you are allergic to nifedipine, any of the active or inactive ingredients in nifedipine formulations, other calcium channel blockers, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, dietary supplements, and herbal products such as St. John’s Wort. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Nifedipine may not be right for people with certain medical conditions such as a recent acute myocardial infarction (heart attack) or coronary artery bypass surgery, preexisting chronic renal insufficiency (kidney disease), liver disease, heart disease, severe gastrointestinal narrowing or intestinal blockage, conditions that cause food to move slowly through the digestive tract or inflammatory bowel disease.

If you are an older adult, age 65 years and above, talk to your provider about the pros and cons of taking nifedipine capsules. There may be other safer treatment options available.

Inform your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Nifedipine

Keep all your medical and lab appointments while on nifedipine. Your doctor will adjust your dose based on your response to the medicine.

Nifedipine can cause dizziness and weakness as side effects. Alcohol can make these side effects worse. Arise slowly from a sitting or lying position to avoid lightheadedness due to low blood pressure.

Tell your doctor if you become pregnant while on nifedipine.

Tell all your healthcare providers you are on nifedipine before any surgery, including dental procedures.

Nifedipine Drug Interactions

Certain other drugs can affect how nifedipine works. Possible interactions with other medicines can increase the risk of severe adverse events. The following medications can have drug interactions with nifedipine:

Anticoagulants or blood thinners such as warfarin (Jantoven, Coumadin)
Diabetes medications such as acarbose (Precose) and metformin (Glucophage)
Antifungal agents such as itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and fluconazole (Diflucan)
Beta blockers such as metoprolol (Lopressor, Toprol XL, in Dutoprol), propranolol (Inderal, Innopran, in Inderide), atenolol (Tenormin), labetalol (Trandate), nadolol (Corgard, in Corzide), and timolol
Anti-seizure medications such as carbamazepine (Carbatrol, Tegretol, Epitol), phenobarbital, valproic acid (Depakene), and phenytoin (Dilantin, Phenytek)
H2 blockers such as cimetidine (Tagamet)
Heart medications such as digoxin (Lanoxin)
Medications for heart rhythm abnormalities such as flecainide (Tambocor) and quinidine (in Nuedexta)
Other calcium channel blockers such as diltiazem (Cardizem) and verapamil (Calan, Verelan, Covera, in Tarka)
Medications prescribed for enlarged prostate glands, such as doxazosin (Cardura)
Antibiotics such as erythromycin (Erythrocin, E.E.S., E-Mycin), quinupristin and dalfopristin (Synercid), rifapentine (Priftin), and rifampin (Rimactane, Rifadin, in Rifater, in Rifamate)
Opioid painkillers such as fentanyl (Actiq, Fentora, Duragesic)
HIV medications such as atazanavir (Reyataz), amprenavir (Agenerase), delavirdine (Rescriptor), indinavir (Crixivan), ritonavir (Norvir, in Kaletra), fosamprenavir (Lexiva), and nelfinavir (Viracept)
Antidepressants such as nefazodone
Immunosuppressants such as tacrolimus (Astagraf SL, Prograf)

The above list may not include all the potential drug interactions of nifedipine. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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